20030381.pdfSjAjDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEJNAME OF.BUSINESS J '; /
o3 I PERMITEXPIRES
USE PERMIT
ZONE
NUMBER
JOB SUITEIAPT#
ADDRESS 3
01 AT NAMEiSUnnivicirtm kin I OT NO LID NO
LLD F
MAILING AdDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
RW Permit NfioVq`uor8d
street Use Permit Req d
Inspection Required 13
Sidewalk Required 0
Underground
I wiring requirw
C ZIP
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TE;HONE S-All '�_j 3 *:r�
0
NAME
METER SIZE
LINE Sli7
NO. OF FIXTURES
PRV REQUIRED
YES C3 N 0 13
ADDRESS
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP
ITELEPHONE
NAME CBL#
��
ADDRESS
JA /a 418
VIP I TELEPHONE
K_ Ov 6),?j4-f -- d.2 "M
STATE LICENSE NUMBER EXPIRATfON DATE I CHECAEeffli,
7"-�"e-olkF
PROPERTY TAX ACCOUNT PARCEL NO
MUST BE �-RESENT FOR
ENGINEEqAW-T9M, REMOVAL, OR CAPATE
FIRE REVIEWED BY DATE uLl
cc
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VARIANCE OR CU SHORELINE OR ADB11 I INSPECTION I BOND
REO'D POSTED
C3YES ONO $ 1
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE I EXEMPT ALLOWED I PROPOSED I ALLOWED I PROPOSED
:2 ?41 Z) 34 111� 14�7_ 1EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
NEW RESIDENTIAL E] PLUMBING/MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
COMPLIANCE OR
E] ADDITION COMMERCIAL z
DCHANGE OF USE I z
PARKING LOT AREA PLANNING REVIEWED 13Y DATE
13 REMODEL
MULTIFAMILY
Li SIGN
REO'D
I PROVIDED
REPAIR
GRADING
13 CYDS
FENCE
( X
REMARKS
I
DEMOLISH
TANK
- -Fr)
OTHER
GARAGE
CARPORT
RETAININGWALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE. BUSINESSf45ftACTIVM
NUMBER O)p
OF
Nu BER C
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
HEAT SOURCE
PLAN CHECK NO:
CRITICAL
AREAS
NUMBER
% I LOT SLOPE %
I VESTED DATE
CHECKED BY I TYPE O�� I C?Q
OCCUPANT
GROUP
SPECIAL INSPECTION JARtA OCCUPANT
REQUIRED [I YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REO'D I �
VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
Building Permit 15 City Surcharge
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURSS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Grading
Engr. Review
SEPARATE PERMISSION.
PERMiTAPPLICATION: ISODAYS
PERMIT LIMIT I YEAR ' PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
Fire Review
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Landscapeinsp.
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CI1YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
I
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
CALL
FOR INSPECTION
W0RKMEN3Sj1M%NSATION INSURANCE AND RCW 18.27.
(425)
771-0220
EXT 1333
SIGNA�T'=
14
DATE SIGNED
'�
WANTION
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
PIPLICATION APPROVAL
This app tion Is not a permit until signed by the
r
dk*.Pfficial r his/her Deputy: and Fees are paid, and
,ocelptall5t cknowledged In space 52!!T.
VATE
DATE
I-VIS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I-
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING
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At 91 FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: - L"-- FIRE DEPARTMENT DATE
1.) ".ZMBM
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE—
PERMIT ADB#_________pATE INSPECTED
Agdaledl :.:
DESCRIPTION OF WORK TO BE INSPECTED-- — 74-
A fleld inspection was conducted to determine rwal compliance with approved plans.� Final approval
denotes that there are no objections from the above signed Department to the release - of
pERFORM—ANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRAM PROJECT APPROVAL WITH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
I .
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
C, Copy of CORRECTION NOTICE given to owner/contractor by inspector
I .
2.
3.
RE_INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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Jun 13 03 05:25a
-3
TANKS BY DA.,UAS D AT E L I,
19t5l 40TH Ft. NE
PAGES:, w
LAKE FOREST PARKj WA'981 55 (INCLUDING COVER)
365-0291 / FAX 361-0992
LICENSED, BONDEDir & INSURED
TANKSD*034KH
---------------------------------------------------------
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aw needs W c0goed WA& He and b1s go* that ba im Moagil I .0t
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tab hfta Pok lftg room whoum gdd ftm Howtm a
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vft- am ww pmety. ro "aly. TUML ww4cbod to Banad.
�9 due dont MI- ac*4 to be a nceiv-
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ca cd amb bosw caw o17 TUL babW to beW
hdU by Dibe ou yew w fty "Wo IMM lze-.0 am people IM tw
1bg can use =wMinibme =
raftsd am mm People we, VFM- =AY IV siid Ma& oll
bdWg that Ilme Is mom d meet to empty uwmed
mg ca dw votdd be u2ted. 50 vw" an)=
redmim to doo a peed d= we man keep vp wig
=W=Ut"Obwoes nd ckladY Dan " mcar people mod about gDod Won to got.
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arnenm in out hnm-
Jun 13 03 01:30p
k k IMF Nal
TANKS BY DALLAS and ij;a2- A44 Lk,
agree to the following terms and conditions:
TANKS BY DALLAS will abandon the unused underground heating
oii tank located at —
TANKS BY DALLAS will pump out and remove all existing fluids
in the, tank. The tank will then be removed and disposed of as
recommend by the Washington State Department of Ecology. In
the event that the tank site should contain any contaminates of
any kind, additional services and charges may be required to
treat/dispose of found contaminates. In addition, TANKS BY
DALLAS is not liable for underground conditions at this time or
any time in the future. Furthermore, TANKS BY DALLAS will
make all means to leave your site as close as possible to its
original condition. . The above services will cost $-ZEt�� +
8.e% Sales Tax$AL-6-1D and applicable permit fees(If required)
y;V1t-,1- I:, -
for a total sum of V - that is to be paid upon
completion of the service. The signatures below Indicate that
the signee and DALLAS GIGRICH have entered Into a binding
agreement with an understanding and agreement to the terms
and conditions specified above.
CUSTOMER DATE DALLAS G106H DATE
DALLAS GIGRICH has completed and met the conditions cited
above and certifies that the oil tank mentioned in the above site
has been properly abandoned.
DALLAS GIGRICH DATE
Make checks to Dallas Gigrich
19551 40th PL NE SEATTLE, WA 981 SS (206) 365-0291
OWNER-� ZZJ��C-- AGENT ---
ADDRESS COMPANY--
CtTY/zIP ADDRESS
PHONE - 2-4 -TZ-3 2- PHONE.
CLOSING DATE ESCROW-
p. 2
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .................
FOUNDATION:
Footing .......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
GasTest ....................
GasPiping .................
Equipment.................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .............
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DATE RECEIV PERMIT EXPIRES
Milt: PERMIT
ZONE
CITY OF EDMONDS NUMBERW-, k-x--J
CONSTRUCTION PERMIT APPLICATION -JOB SUITE/APT#
ADDRESS
L
OWNER 0 BUSINESS PLAT NAME/SUBDIVISION N07'70. LID NO.
LID FEE $
MAILING A61DRESS TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
/77,0/7 .7 IV Street ute Pannit Req'd
InspecUo Required 13
— �TE�LPHONE EXISTING — PROPOSED Sldewalk%equlred CI
underground
s- 3 REQUIRED DEDICATION— FT WirIngtoquired 13
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED 0
NAME YES 13 NO C3
z
REMARKS z
ADDRESS OWNEFIXONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE I
CITY
ZIP
NA�ME� 2L CBL # /-\�21
P
ADDRESS V- 10s:
TELEPHONE
C V 'P
Ex, 10 7j 17els
STATE LICENSE NUMBER r'
r
3ROPERTY TAX ACCOUNT PARCEL NO.
'? 7,4 4�-.2
e? —,o -3 4
0 NEW
RESIDENTIAL
[] ADDITION
COMMERCIAL
0 REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
>�TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
I[TYPE OF USE. BUSINESS^ACTIV" EXPOIN:
C,�-n Y-51-77�
NUMBER
OF
0
�
NUMBER 00
DWELLING
1
STORIES .1
UNITS
DESCRIBE WORK TO BE DONE
HEAT j-0—URCE GLAZING %
___ I
PLAN CHECK NO:
I
FIRE REVIEWED BY
AL
I
DATE
VARIANCE OR CU SHORELINE -OR ADB# I INSPECTION BOND
REO'D POSTED
SEPA REVIEW SIGN AREA t13YES 13NO 1$ HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
PLUMBING I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
LE
COMPLIANCE OR z
0 CHANGE OF USE PARKING LOT AREA PLANNING HEVIEWED BY DATE
[:] SIGN REQ'D I PROVIDED
FENCE
( X FT) REMARKS
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
LOT SLOPE %
VESTED DATE
CHECKED BY TYPE OF OCCUPANT io
GROUP V[:;)
OCCUPANT
SPECIAL INSPECTION JARtA LOAD
REQUIRED []YES
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECT112tLE170 15
r�
VALUATION
DescriptIon FEE_
Plan Check
Building Permit
Plumbing
Mechanical
Description FEE
State Surcharge
City Surcharge I
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
-APPLICATION APPROVAL
This �pli6ation is not a permit until signed by the
LiNding Otliciall 4r his/her Deputy: and roes are paid, and
. f
, rec�lpt ls,40nowledged ig spacjE���
LE4E By �DATE
Asu—NLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE - YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109 PINK -OWNER - GOLD -ASSESSOR
04102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
B E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBILIC
Grading
rad'ng
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
E
SEPARATE PERMISSION.
ew
. ReviE
Engr. Review
E g rE
n
t
PERMIT APPUCATION: 180 DAYS
PERMIT uMrp I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
En n ection
�gr. I sp
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review
*APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
Fire Inspec tion
IN INTEREST, AGREES TO INDEMNIFY� DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp-
Recording Fee
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WORKMEN'��NSATION INSURANCE AND RCW 18.27.
IA951
SIGNAT E,( AGEN -
DATE SIGNED
771-0220
EXT 1333
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